The headlines about changes announced by the Secretary of State for Health last week have been glaring. Jeremy Hunt’s attempts to introduce a “Seven day NHS” caused junior doctors to take to the streets of London publically claiming the proposed changes to their hours were unfair for them and unsafe for patients. The Department of Health has responded saying the BMA has misrepresented the plan to its members and that it is willing to negotiate. They’re both hunkering down for a fight. Whatever your view, it will be an interesting case study for implementing change.
The whole of life seems to be about change, but people often dislike it (how often have you heard that phrase “but we always do it like this!”?) are suspicious of it and resist it. We have often seen some parts of the union movement attempt to stop the commercial clock, even though change is necessary and inevitable. Change in our private lives and at work can be difficult and yes, upsetting. Sometimes we just have to deal with it.
In the NHS it is a particular challenge. It’s not just about delivering a good service, it’s about delivering it in a politically acceptable way. It takes a long time to train doctors. Lower skilled workers can, if necessary, be “turned over” relatively quickly and the replacements inducted into the new order from day one, it could take a generation for new junior doctors to enter the NHS without feeling cheated over working hours unless a solution is reached.
Mr Hunt had a difficult starting point. A business can adopt a decision to change but choose to announce and implement it in a phased way to bring the workforce along with it (for example, building from a five to a six day service, and then up to seven days),a politician doesn’t have that luxury. The policy aim of achieving a seven day NHS was announced in the run-up to the election, and the government has five years to get it done. The BMA and its members are now fully aware of the intended outcome so can focus on preventing it, regardless of whether implementation is reasonable or not.
The BMA may not be in as strong a position as it thinks though, despite its monopoly over the workforce. The government has been elected to achieve a seven day service and is, in effect, in charge of the NHS. The public have been getting seven day service from a good deal of the private sector for years. That tends to change expectations and it causes frustrations that it can be so difficult to access some medical services. A seven day NHS is popular amongst the voters, as it shows their beloved NHS is being protected and improved. It also reduces the need to take time off to see the doctor during working hours. If doctors choose to simply resist the policy, then their popular position amongst the people may start to shake. The BMA’s objection ought to be the way the government is trying to change doctors’ hours, not the aim of a better service. If they offered an alternative solution, they would be on a much stronger ground.
Effecting change in a workforce which is seeking to resist your plans can be tough. It is most effectively achieved when those affected are informed and consulted about the plans and then changes take place incrementally. It gives the organisation the time to test the changes, correct any problems and then repeat. It also give people time to get used to the idea. Big bang approaches make good headlines and often bad processes.
There are all sorts of tactics to get individuals to accept change – information, consultation, negotiation, buying out benefits, using “champions” to sell the need for change to others, changing the contracts of incomers so over time the changes are introduced, albeit slowly, and, as a last resort, considering dismissal for some other substantial reason. SOSR is very much the act of last resort as it can lead to unfair dismissal claims, industrial unrest and great bitterness. The aims of an organisation have to be balanced with what is realistic.
The ultimate challenge is to bring your workforce along with you after implementing the change so that they embrace the new system, work with it and make it a success. People need to feel that they’ve had a fair deal, that they are wanted and valued. If they don’t, they will either cause trouble from within or go. Good riddance you may think. That’s fine, as long as you can bear the costs of recruiting replacements, and the PR around the changes hasn’t damaged your external reputation.
Change can be uncomfortable but we all have to accept it at times, and providing a better service to keep the organisation relevant should be a reason you can sell to your workforce. The competitive nature of the private sector should give you an advantage in explaining the need for change, but also act as a threat by giving your employees somewhere else to go if they reject it.
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